10032

Ɉɛɪɚɡɟɰ N 4

ȺɅɖȻɈɆ

ɫɮɨɬɨɝɪɚɮɢɹɦɢ, ɮɨɬɨɧɟɝɚɬɢɜɚɦɢ ɢ ɭɫɬɚɧɨɜɨɱɧɵɦɢ ɞɚɧɧɵɦɢ ɧɚ ɨɫɭɠɞɟɧɧɵɯ, ɫɤɥɨɧɧɵɯ ɤ ɫɨɜɟɪɲɟɧɢɸ ɩɨɛɟɝɚ, ɥɢɰ, ɩɨɥɶɡɭɸɳɢɯɫɹ ɩɪɚɜɨɦ ɩɟɪɟɞɜɢɠɟɧɢɹ ɛɟɡ ɤɨɧɜɨɹ

ɢɥɢ ɫɨɩɪɨɜɨɠɞɟɧɢɹ, ɚ ɬɚɤɠɟ ɩɪɨɠɢɜɚɸɳɢɯ ɡɚ ɩɪɟɞɟɥɚɦɢ ɤɨɥɨɧɢɢ

_________________________________________

(ɧɚɢɦɟɧɨɜɚɧɢɟ ɜɨɫɩɢɬɚɬɟɥɶɧɨɣ ɤɨɥɨɧɢɢ)

__________________________________________________________________

(ɭɫɬɚɧɨɜɨɱɧɵɟ ɞɚɧɧɵɟ ɧɚ ɨɫɭɠɞɟɧɧɨɝɨ, ɫɥɨɜɟɫɧɵɣ ɩɨɪɬɪɟɬ, ɮɢɡɢɱɟɫɤɢɟ

__________________________________________________________________

ɧɟɞɨɫɬɚɬɤɢ ɢ ɨɫɨɛɵɟ ɩɪɢɦɟɬɵ, ɤɥɢɱɤɚ, ɧɨɦɟɪ ɨɬɪɹɞɚ, ɛɪɢɝɚɞɵ, ɚɞɪɟɫ

__________________________________________________________________

ɦɟɫɬɨɠɢɬɟɥɶɫɬɜɚ ɞɨ ɨɫɭɠɞɟɧɢɹ, ɫɩɢɫɨɤ ɪɨɞɫɬɜɟɧɧɢɤɨɜ ɢ ɢɧɵɟ ɫɜɹɡɢ)

__________________________________________________________________

ɉɪɢɦɟɱɚɧɢɹ:

- ɚɥɶɛɨɦ ɫɨɫɬɨɢɬ ɢɡ ɞɜɭɯ ɱɚɫɬɟɣ: 1 - ɞɥɹ ɫɤɥɨɧɧɵɯ ɤ ɩɨɛɟɝɭ,

2 - ɞɥɹ ɨɫɭɠɞɟɧɧɵɯ, ɩɨɥɶɡɭɸɳɢɯɫɹ ɩɪɚɜɨɦ ɩɟɪɟɞɜɢɠɟɧɢɹ ɛɟɡ ɤɨɧɜɨɹ ɢɥɢ ɫɨɩɪɨɜɨɠɞɟɧɢɹ;

-ɨɛɧɨɜɥɹɟɬɫɹ ɩɨ ɦɟɪɟ ɫɧɹɬɢɹ ɫ ɭɱɟɬɚ ɢɥɢ ɩɨɫɬɚɧɨɜɤɢ ɧɚ ɭɱɟɬ ɞɪɭɝɢɯ ɥɢɰ;

-ɤ ɚɥɶɛɨɦɭ ɩɪɢɥɚɝɚɸɬɫɹ ɨɪɢɟɧɬɢɪɨɜɤɢ.

Ɉɛɪɚɡɟɰ N 5

ɀɍɊɇȺɅ ɭɱɟɬɚ ɢɡɴɹɬɵɯ ɭ ɨɫɭɠɞɟɧɧɵɯ ɞɟɧɟɝ ɢ ɰɟɧɧɨɫɬɟɣ

_________________________________________

(ɧɚɢɦɟɧɨɜɚɧɢɟ ɜɨɫɩɢɬɚɬɟɥɶɧɨɣ ɤɨɥɨɧɢɢ)

ɉɪɢɦɟɱɚɧɢɟ. ȼ ɠɭɪɧɚɥɟ ɭɱɢɬɵɜɚɸɬɫɹ ɞɟɧɶɝɢ ɢ ɰɟɧɧɨɫɬɢ, ɢɡɴɹɬɵɟ ɭ ɨɫɭɠɞɟɧɧɵɯ, ɚ ɬɚɤɠɟ ɨɛɧɚɪɭɠɟɧɧɵɟ ɫɨɬɪɭɞɧɢɤɚɦɢ ȼɄ ɧɚ ɬɟɪɪɢɬɨɪɢɢ ɤɨɥɨɧɢɢ.

Ɉɛɪɚɡɟɰ N 6

361

Приложение N 7 к Инструкции

ȺɄɌ

ɉɪɨɜɟɞɟɧ ɨɛɵɫɤ (ɨɫɦɨɬɪ) ɩɨ ɭɬɜɟɪɠɞɟɧɧɨɦɭ ɝɪɚɮɢɤɭ, ɜɧɟɩɥɚɧɨɜɵɣ (ɧɭɠɧɨɟ ɩɨɞɱɟɪɤɧɭɬɶ)

______________________________________________________________

(ɭɤɚɡɚɬɶ ɜɪɟɦɹ, ɨɛɴɟɤɬ, ɮɚɦɢɥɢɸ ɨɫɭɠɞɟɧɧɨɝɨ)

ɜ ɩɪɢɫɭɬɫɬɜɢɢ ɨɫɭɠɞɟɧɧɨɝɨ ________________________________________

ɧɚɱɚɥɶɧɢɤɚ ɨɬɪɹɞɚ ɢɥɢ ɞɪ. ɞɨɥɠɧɨɫɬɧɨɝɨ ɥɢɰɚ ______________________

______________________________________________________________

ɫ ɰɟɥɶɸ ɨɛɧɚɪɭɠɟɧɢɹ ɡɚɩɪɟɳɟɧɧɵɯ ɤ ɯɪɚɧɟɧɢɸ ɨɫɭɠɞɟɧɧɵɦɢ ɩɪɟɞɦɟɬɨɜ ɢ ɜɟɳɟɫɬɜ, ɩɨɞɤɨɩɨɜ.

ȼ ɪɟɡɭɥɶɬɚɬɟ ɨɛɧɚɪɭɠɟɧɵ ɢ ɢɡɴɹɬɵ _____________________________

______________________________________________________________

(ɝɞɟ, ɱɬɨ, ɭ ɤɨɝɨ)

Ɋɭɤɨɜɨɞɢɬɟɥɶ ɨɛɵɫɤɚ (ɨɫɦɨɬɪɚ) ________________________________

______________________________________________________________

(ɞɨɥɠɧɨɫɬɶ, ɫɩɟɰɢɚɥɶɧɨɟ ɡɜɚɧɢɟ, ɮɚɦɢɥɢɹ, ɢɧɢɰɢɚɥɵ, ɩɨɞɩɢɫɶ)

Ʌɢɰɚ, ɩɪɢɧɢɦɚɜɲɢɟ ɭɱɚɫɬɢɟ ɜ ɨɛɵɫɤɟ (ɨɫɦɨɬɪɟ) _________________

______________________________________________________________

(ɞɨɥɠɧɨɫɬɢ, ɫɩɟɰɢɚɥɶɧɵɟ ɡɜɚɧɢɹ, ɮɚɦɢɥɢɢ, ɢɧɢɰɢɚɥɵ, ɩɨɞɩɢɫɢ)

Ʌɢɰɨ, ɩɪɢɧɹɜɲɟɟ ɢɡɴɹɬɵɟ ɜɟɳɢ _________________________________

(ɞɨɥɠɧɨɫɬɶ, ɫɩɟɰɢɚɥɶɧɨɟ ɡɜɚɧɢɟ, ɮɚɦɢɥɢɹ, ɢɧɢɰɢɚɥɵ)

ɉɪɢɦɟɱɚɧɢɟ.

Ɋɟɡɭɥɶɬɚɬɵ ɨɛɵɫɤɚ (ɨɫɦɨɬɪɚ) ɞɨɤɥɚɞɵɜɚɸɬɫɹ ɧɚɱɚɥɶɧɢɤɭ ɤɨɥɨɧɢɢ ɢɥɢ ɟɝɨ ɡɚɦɟɫɬɢɬɟɥɸ ɩɨ ɨɩɟɪɚɬɢɜɧɨɣ ɪɚɛɨɬɟ ɢ ɪɟɠɢɦɭ. Ɉ ɩɪɢɧɹɬɨɦ ɪɟɲɟɧɢɢ ɧɚ ɚɤɬɟ ɩɢɫɶɦɟɧɧɨ ɞɚɟɬɫɹ ɭɤɚɡɚɧɢɟ ɤɨɧɤɪɟɬɧɨɦɭ ɞɨɥɠɧɨɫɬɧɨɦɭ ɥɢɰɭ (ɩɪɨɜɟɫɬɢ ɫɥɭɠɟɛɧɨɟ ɪɚɫɫɥɟɞɨɜɚɧɢɟ, ɭɧɢɱɬɨɠɢɬɶ ɩɪɟɞɦɟɬɵ, ɫɞɚɬɶ ɞɟɧɶɝɢ, ɰɟɧɧɵɟ ɜɟɳɢ ɜ ɛɭɯɝɚɥɬɟɪɢɸ).

363

Приложение N 8 к Инструкции

ɇɚɱɚɥɶɧɢɤ ___________________ ȼɄ

______________________

(ɩɨɞɩɢɫɶ)

"__" ___________ 200_ ɝ.

ȽɊȺɎɂɄ ɩɪɨɜɟɞɟɧɢɹ ɨɛɵɫɤɨɜ ɢ ɨɫɦɨɬɪɨɜ ɧɚ _______ 200_ ɝ.

ɦɟɫɹɰ

ňņņņņņņņņņņņņņņņņņņņņņņņņņņņņŎņņņņņņņņņņņņņņņņņņņņņņņņŎņņņņņņņņņņʼn

ŌņņņņņņņņņņņņņņņņņņņņņņņņņņņņŐņņŐņņŐņņŐņņŐņņŐņņŐņņņņņņŐņņņņņņņņņņō Ň 1 Ň2 Ň3 Ň4 Ň5 Ň6 Ň7 Ň 8 Ň 9 Ň Ōņņņņņņņņņņņņņņņņņņņņņņņņņņņņŏņņŏņņŏņņŏņņŏņņŏņņŏņņņņņņŏņņņņņņņņņņō

Ŋņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņņŋ

Ɂɚɦɟɫɬɢɬɟɥɶ ɧɚɱɚɥɶɧɢɤɚ _________________________ ȼɄ ɩɨ ɨɩɟɪɚɬɢɜɧɨɣ ɪɚɛɨɬɟ ɢ ɪɟɠɢɦɭ _________________

(ɩɨɞɩɢɫɶ)

"__" ___________ 200_ ɝ.

364

Приложение N 9 к Инструкции

ɉɅȺɇ ɩɪɨɜɟɞɟɧɢɹ ɨɛɳɟɝɨ ɨɛɵɫɤɚ ɜ ________ ȼɄ

ɐɟɥɶ ɨɛɵɫɤɚ: ɨɛɧɚɪɭɠɟɧɢɟ ɢ ɢɡɴɹɬɢɟ ɩɪɟɞɦɟɬɨɜ, ɢɡɞɟɥɢɣ, ɜɟɳɟɫɬɜ, ɯɪɚɧɟɧɢɟ ɤɨɬɨɪɵɯ ɨɫɭɠɞɟɧɧɵɦ ɡɚɩɪɟɳɟɧɨ.

Ⱦɚɬɚ ɢ ɜɪɟɦɹ ɩɪɨɜɟɞɟɧɢɹ: ɧɚɱɚɥɨ ɨɛɵɫɤɚ _______________________

ɤɨɧɟɰ ɨɛɵɫɤɚ ________________________

ɋɢɥɵ, ɩɪɢɜɥɟɤɚɟɦɵɟ ɤ ɨɛɵɫɤɭ: ɧɚɱɚɥɶɫɬɜɭɸɳɢɣ ɫɨɫɬɚɜ ȼɄ ____ ɱɟɥ.

Ɍɟɯɧɢɱɟɫɤɢɟ ɢ ɢɧɵɟ ɫɪɟɞɫɬɜɚ __________________________________

ɍɱɚɫɬɨɤ N 1 __________________________________________________

(ɧɚɢɦɟɧɨɜɚɧɢɟ ɨɛɴɟɤɬɚ, ɬɟɪɪɢɬɨɪɢɢ, ɜɪɟɦɹ

______________________________________________________________

ɩɪɨɜɟɞɟɧɢɹ ɨɛɵɫɤɚ, ɪɭɤɨɜɨɞɢɬɟɥɶ ɢ ɫɨɫɬɚɜ ɨɛɵɫɤɨɜɨɣ ɝɪɭɩɩɵ, ɩɪɢɞɚɧɧɵɟ ɬɟɯɧɢɱɟɫɤɢɟ ɢ ɢɧɵɟ ɫɪɟɞɫɬɜɚ)

ɍɱɚɫɬɨɤ N 2 __________________________________________________

Ʌɢɱɧɵɣ ɨɛɵɫɤ ɨɫɭɠɞɟɧɧɵɯ ɩɪɨɜɨɞɢɬɫɹ ___________________________

______________________________________________________________

(ɜɪɟɦɹ, ɦɟɫɬɨ ɩɪɨɜɟɞɟɧɢɹ, ɪɭɤɨɜɨɞɢɬɟɥɶ, ɫɨɫɬɚɜ ɨɛɵɫɤɨɜɨɣ

______________________________________________________________

ɝɪɭɩɩɵ, ɩɪɢɞɚɧɧɵɟ ɬɟɯɧɢɱɟɫɤɢɟ ɫɪɟɞɫɬɜɚ)

Ⱦɨ ɨɤɨɧɱɚɧɢɹ ɨɛɵɫɤɚ ɨɫɭɠɞɟɧɧɵɟ ɫɨɫɪɟɞɨɬɨɱɢɜɚɸɬɫɹ _____________

______________________________________________________________

(ɦɟɫɬɨ ɫɨɫɪɟɞɨɬɨɱɟɧɢɹ ɢ ɩɪɨɜɨɞɢɦɵɟ ɦɟɪɨɩɪɢɹɬɢɹ)

Ɉɬɜɟɬɫɬɜɟɧɧɵɣ ɡɚ ɫɛɨɪ, ɯɪɚɧɟɧɢɟ, ɭɧɢɱɬɨɠɟɧɢɟ ɢɡɴɹɬɵɯ ɢɡɞɟɥɢɣ, ɩɪɟɞɦɟɬɨɜ, ɜɟɳɟɫɬɜ ɢ ɞɨɤɭɦɟɧɬɢɪɨɜɚɧɢɟ ɪɟɡɭɥɶɬɚɬɨɜ ɨɛɵɫɤɚ

______________________________________________________________

(ɞɨɥɠɧɨɫɬɶ, ɫɩɟɰɢɚɥɶɧɨɟ ɡɜɚɧɢɟ, ɮɚɦɢɥɢɹ, ɢɧɢɰɢɚɥɵ)

ɂɧɫɬɪɭɤɬɚɠ ɧɚɡɧɚɱɟɧ ɧɚ _______________________________________

(ɜɪɟɦɹ, ɦɟɫɬɨ ɩɪɨɜɟɞɟɧɢɹ)

ɉɨɞɜɟɞɟɧɢɟ ɢɬɨɝɨɜ ɧɚɡɧɚɱɟɧɨ ɧɚ _______________________________

(ɜɪɟɦɹ ɢ ɦɟɫɬɨ)

Ɋɭɤɨɜɨɞɢɬɟɥɶ ɨɛɵɫɤɚ ɧɚɱɚɥɶɧɢɤ ȼɄ _____________________________

(ɫɩɟɰɢɚɥɶɧɨɟ ɡɜɚɧɢɟ,

______________________________________________________________

ɮɚɦɢɥɢɹ, ɢɧɢɰɢɚɥɵ, ɩɨɞɩɢɫɶ)

"__" _____________ 200_ ɝ.

365

Приложение N 10 к Инструкции

ɀɍɊɇȺɅ ɪɟɝɢɫɬɪɚɰɢɢ ɬɟɥɟɮɨɧɧɵɯ ɪɚɡɝɨɜɨɪɨɜ ɨɫɭɠɞɟɧɧɵɯ

___________________________________________

(ɧɚɢɦɟɧɨɜɚɧɢɟ ɜɨɫɩɢɬɚɬɟɥɶɧɨɣ ɤɨɥɨɧɢɢ)

ɇɚɱɚɬ ______________

Ɉɤɨɧɱɟɧ ____________

366

Приложение N 11 к Инструкции

ȼɄ _______________________

Ɉɬɪɹɞ N __________________

Ʌɢɱɧɨɟ ɞɟɥɨ N ____________

ɄȺɊɌɈɑɄȺ ɭɱɟɬɚ ɫɜɢɞɚɧɢɣ, ɜɵɞɚɱɢ ɩɨɫɵɥɨɤ, ɩɟɪɟɞɚɱɢ ɢ ɛɚɧɞɟɪɨɥɟɣ

Ɏɚɦɢɥɢɹ _____________ ɂɦɹ ____________ Ɉɬɱɟɫɬɜɨ __________________

Ƚɨɞ ɪɨɠɞɟɧɢɹ ________________ ɫɬ. ________________________________

ɋɪɨɤ ___________ ɇɚɱɚɥɨ ɫɪɨɤɚ ______________ Ʉɨɧɟɰ ɫɪɨɤɚ _________

ɇɨɪɦɵ ɫɜɢɞɚɧɢɣ ɜ ɝɨɞ ɉɪɢ ɩɨɫɬɭɩɥɟɧɢɢ:

ɤɪɚɬɤɨɫɪɨɱɧɵɯ ____________

ɞɥɢɬɟɥɶɧɵɯ _______________

ɉɪɢ ɢɡɦɟɧɟɧɢɢ ɭɫɥɨɜɢɣ ɨɬɛɵɜɚɧɢɹ ɧɚɤɚɡɚɧɢɹ:

____________________________ _______________________________

(ɞɚɬɚ ɩɟɪɟɜɨɞɚ ɢ ɭɫɥɨɜɢɹ) (ɞɚɬɚ ɩɟɪɟɜɨɞɚ ɢ ɭɫɥɨɜɢɹ)

ɤɪɚɬɤɨɫɪɨɱɧɵɯ ______________ ɤɪɚɬɤɨɫɪɨɱɧɵɯ _________________

ɞɥɢɬɟɥɶɧɵɯ _________________ ɞɥɢɬɟɥɶɧɵɯ ____________________

____________________________ _______________________________

(ɞɚɬɚ ɩɟɪɟɜɨɞɚ ɢ ɭɫɥɨɜɢɹ) (ɞɚɬɚ ɩɟɪɟɜɨɞɚ ɢ ɭɫɥɨɜɢɹ)

ɤɪɚɬɤɨɫɪɨɱɧɵɯ ______________ ɤɪɚɬɤɨɫɪɨɱɧɵɯ _________________

ɞɥɢɬɟɥɶɧɵɯ _________________ ɞɥɢɬɟɥɶɧɵɯ ____________________

1. Ɋɨɞɫɬɜɟɧɧɢɤɢ ɨɫɭɠɞɟɧɧɨɝɨ

ɉɪɢɦɟɱɚɧɢɹ:

1.Ʉɚɪɬɨɱɤɢ ɯɪɚɧɹɬɫɹ ɭ ɦɥɚɞɲɟɝɨ ɢɧɫɩɟɤɬɨɪɚ ɩɨ ɜɵɞɚɱɟ ɩɨɫɵɥɨɤ, ɩɟɪɟɞɚɱ ɢ ɛɚɧɞɟɪɨɥɟɣ ɜ ɫɩɟɰɢɚɥɶɧɨɦ ɹɳɢɤɟ ɩɨɞ ɡɚɦɤɨɦ.

2.ɉɪɢ ɭɛɵɬɢɢ ɨɫɭɠɞɟɧɧɨɝɨ ɢɡ ȼɄ ɤɚɪɬɨɱɤɚ ɡɚɜɟɪɹɟɬɫɹ ɡɚɦɟɫɬɢɬɟɥɟɦ ɧɚɱɚɥɶɧɢɤɚ ɤɨɥɨɧɢɢ ɩɨ ɨɩɟɪɚɬɢɜɧɨɣ ɪɚɛɨɬɟ

ɢɪɟɠɢɦɭ ɢ ɩɪɢɨɛɳɚɟɬɫɹ ɤ ɥɢɱɧɨɦɭ ɞɟɥɭ.

3.Ʉɚɪɬɨɱɤɚ ɢɡɝɨɬɚɜɥɢɜɚɟɬɫɹ ɧɚ ɩɥɨɬɧɨɣ ɛɭɦɚɝɟ.

4.ɉɟɪɜɵɣ ɪɚɡɞɟɥ ɤɚɪɬɨɱɤɢ ɡɚɩɨɥɧɹɟɬɫɹ ɫɨɬɪɭɞɧɢɤɨɦ ɨɬɞɟɥɚ ɫɩɟɰɢɚɥɶɧɨɝɨ ɭɱɟɬɚ ɢ ɩɨɞɩɢɫɵɜɚɟɬɫɹ ɟɝɨ ɧɚɱɚɥɶɧɢɤɨɦ.

5.ȼ ɫɥɭɱɚɟ ɡɚɦɟɧɵ ɫɜɢɞɚɧɢɹ ɧɚ ɬɟɥɟɮɨɧɧɵɣ ɪɚɡɝɨɜɨɪ ɜ ɤɚɪɬɨɱɤɟ ɞɟɥɚɟɬɫɹ ɨɬɦɟɬɤɚ.

367

Приложение N 12 к Инструкции

ɁȺəȼɅȿɇɂȿ

Ɉɬ ɝɪ. ___________________________________________________________

(ɮɚɦɢɥɢɹ, ɢɦɹ, ɨɬɱɟɫɬɜɨ)

ɩɪɨɠɢɜɚɸɳɟɝɨ _____________________________________________________

(ɚɞɪɟɫ)

ɉɪɨɲɭ ɩɪɢɧɹɬɶ ɩɟɪɟɞɚɱɭ ɞɥɹ ɨɫɭɠɞɟɧɧɨɝɨ ___________________________

(ɮɚɦɢɥɢɹ, ɢɦɹ, ɨɬɱɟɫɬɜɨ

______________________________________________________________

ɢ ɝɨɞ ɪɨɠɞɟɧɢɹ)

Ɉɩɢɫɶ ɩɪɨɞɭɤɬɨɜ (ɩɪɟɞɦɟɬɨɜ) ɩɟɪɟɞɚɱɢ

ɉɨɞɩɢɫɶ ɩɟɪɟɞɚɸɳɟɝɨ ɥɢɰɚ ________________

"__" ____________ 200_ ɝ.

ɉɟɪɟɞɚɱɭ ɩɪɢɧɹɥ ______________________________________________

(ɮɚɦɢɥɢɹ, ɢɧɢɰɢɚɥɵ, ɩɨɞɩɢɫɶ ɦɥɚɞɲɟɝɨ ɢɧɫɩɟɤɬɨɪɚ)

"__" ____________ 200_ ɝ.

ɉɟɪɟɞɚɱɭ ɩɨɥɭɱɢɥ _________________________

(ɩɨɞɩɢɫɶ ɨɫɭɠɞɟɧɧɨɝɨ)

"__" ____________ 200_ ɝ.

368

_________________________________________________________________

(ɮɚɦɢɥɢɹ, ɢɦɹ, ɨɬɱɟɫɬɜɨ, ɝɨɞ ɪɨɠɞɟɧɢɹ) ɨɫɭɠɞɟɧɧɵɣ(ɚɹ) ɩɨ ɫɬ. ____________ ɍɝɨɥɨɜɧɨɝɨ ɤɨɞɟɤɫɚ Ɋɨɫɫɢɣɫɤɨɣ

Ɏɟɞɟɪɚɰɢɢ ɤ _________________ ɨɬɛɵɥ ______________________________

ɢ ɯɚɪɚɤɬɟɪɢɡɭɟɬɫɹ ɩɨɥɨɠɢɬɟɥɶɧɨ.

Ɋɭɤɨɜɨɞɫɬɜɭɹɫɶ ɫɬ. __________ ɍɝɨɥɨɜɧɨ-ɢɫɩɨɥɧɢɬɟɥɶɧɨɝɨ ɤɨɞɟɤɫɚ Ɋɨɫɫɢɣɫɤɨɣ Ɏɟɞɟɪɚɰɢɢ, ɞɥɹ ɜɵɩɨɥɧɟɧɢɹ ɪɚɛɨɬ _______________________

__________________________________________________________________

ɨɬ _____________________________ ɞɨ ______________________________

ɇɚɱɚɥɶɧɢɤ ȼɄ _________________________________________

(ɫɩɟɰɢɚɥɶɧɨɟ ɡɜɚɧɢɟ, ɮɚɦɢɥɢɹ, ɢɧɢɰɢɚɥɵ)

_________________________________________

(ɩɨɞɩɢɫɶ)

"__" ________ 200_ ɝ.

ɉɨɫɬɚɧɨɜɥɟɧɢɟ ɢ ɩɪɚɜɢɥɚ ɩɨɜɟɞɟɧɢɹ ɦɧɟ ɨɛɴɹɜɥɟɧɵ ɢ ɨɛ ɨɬɜɟɬɫɬɜɟɧɧɨɫɬɢ ɡɚ ɢɯ ɧɚɪɭɲɟɧɢɟ ɩɪɟɞɭɩɪɟɠɞɟɧ(ɚ)

__________________________________

(ɞɚɬɚ ɢ ɩɨɞɩɢɫɶ ɨɫɭɠɞɟɧɧɨɝɨ(ɨɣ))

Ɉɛɨɪɨɬɧɚɹ ɫɬɨɪɨɧɚ

ɉɈɋɌȺɇɈȼɅȿɇɂȿ ɨ ɥɢɲɟɧɢɢ ɨɫɭɠɞɟɧɧɨɝɨ ɩɪɚɜɚ ɧɚ ɩɟɪɟɞɜɢɠɟɧɢɟ

ɛɟɡ ɤɨɧɜɨɹ ɢɥɢ ɫɨɩɪɨɜɨɠɞɟɧɢɹ

Ɉɫɭɠɞɟɧɧɵɣ(ɚɹ) _______________________________________________

(ɮɚɦɢɥɢɹ, ɢɦɹ, ɨɬɱɟɫɬɜɨ, ɝɨɞ ɪɨɠɞɟɧɢɹ) "__" ___________ 200_ ɝ. ɞɨɩɭɫɬɢɥ(ɚ) _____________________________

__________________________________________________________________

(ɢɡɥɚɝɚɸɬɫɹ ɯɚɪɚɤɬɟɪ ɢ ɨɛɫɬɨɹɬɟɥɶɫɬɜɚ ɧɚɪɭɲɟɧɢɹ ɭɫɬɚɧɨɜɥɟɧɧɨɝɨ

__________________________________________________________________

ɩɨɪɹɞɤɚ ɨɬɛɵɜɚɧɢɹ ɧɚɤɚɡɚɧɢɹ ɥɢɛɨ ɩɪɢɱɢɧɵ, ɩɨɫɥɭɠɢɜɲɢɟ ɨɫɧɨɜɚɧɢɟɦ

__________________________________________________________________

ɥɢɲɟɧɢɹ ɩɪɚɜɚ ɧɚ ɩɟɪɟɞɜɢɠɟɧɢɟ ɛɟɡ ɤɨɧɜɨɹ ɢɥɢ ɫɨɩɪɨɜɨɠɞɟɧɢɹ)

Ɋɭɤɨɜɨɞɫɬɜɭɹɫɶ ɫɬ. __________ ɍɝɨɥɨɜɧɨ-ɢɫɩɨɥɧɢɬɟɥɶɧɨɝɨ ɤɨɞɟɤɫɚ Ɋɨɫɫɢɣɫɤɨɣ Ɏɟɞɟɪɚɰɢɢ,

ɉɈɋɌȺɇɈȼɂɅ:

Ɉɫɭɠɞɟɧɧɨɝɨ(ɭɸ) ______________________________________________

(ɮɚɦɢɥɢɹ, ɢɧɢɰɢɚɥɵ)

ɥɢɲɢɬɶ ɩɪɚɜɚ ɩɟɪɟɞɜɢɠɟɧɢɹ ɛɟɡ ɤɨɧɜɨɹ ɢɥɢ ɫɨɩɪɨɜɨɠɞɟɧɢɹ ɡɚ ɩɪɟɞɟɥɚɦɢ ɤɨɥɨɧɢɢ ɫ "__" _______________ 200_ ɝ.

ɇɚɱɚɥɶɧɢɤ ȼɄ _________________________________________

(ɫɩɟɰɢɚɥɶɧɨɟ ɡɜɚɧɢɟ, ɮɚɦɢɥɢɹ, ɢɧɢɰɢɚɥɵ)

_________________________________________

(ɩɨɞɩɢɫɶ)

"__" ________ 200_ ɝ.

369

Приложение N 14 к Инструкции

ɉɊɈɉɍɋɄ N ______

ɧɚ ɩɪɚɜɨ ɜɵɯɨɞɚ ɢ ɩɟɪɟɞɜɢɠɟɧɢɹ ɡɚ ɩɪɟɞɟɥɚɦɢ ɜɨɫɩɢɬɚɬɟɥɶɧɨɣ ɤɨɥɨɧɢɢ

ȼɵɞɚɧ "__" _______ 200_ ɝ. _________________________

(ɩɨɞɩɢɫɶ ɧɚɱɚɥɶɧɢɤɚ ȼɄ)

370